Biomechanical Evaluation of Biodegradable Implants Using Anchoring Fixation Sutures in Apical Prolapse Repair

Apical prolapse, a common form of Pelvic Organ Prolapse (POP), is often linked to weakened support structures such as the uterosacral (USL) and cardinal ligaments (CL), influenced by factors like vaginal childbirth, aging, and obesity. Although surgical mesh use is expected to increase, the Food and Drug Administration (FDA) banned polypropylene mesh for transvaginal anterior compartment prolapse in 2019 due to safety concerns, highlighting the need for alternatives such as biodegradable implants. This study developed four biodegradable mesh implants (square and sinusoidal geometries) mimicking the USL and CL. These were applied within a computational pelvic model to assess biomechanical behavior during the Valsalva maneuver and to explore different fixation methods (continuous, interrupted and simple stitch sutures). Baseline analysis of the healthy model established vaginal displacement under normal conditions. Without implant support, complete CL rupture increased displacement by 34%, and complete USL rupture raised displacement by 69%. Polycaprolactone implants consistently reduced anterior vaginal wall displacement in all impairment scenarios. Square implants mimicking the USL reduced displacement by up to 10% in cases of complete USL rupture with intact CL. Similarly, square implants mimicking the CL reduced displacement by up to 15% with complete CL rupture and healthy USL. Simulations with both ligaments impaired showed that USL contribute to support, while CL play a key role in stabilization. These findings demonstrate the potential of biodegradable implants to enhance POP repair. However, further studies are needed to evaluate long-term degradation and clinical applicability.